• Mokhtar Elhakim, Hany Abd-Elfattah, Dalia Nasr El-Din, Reem El-Kabarity, Azia Atef, and Atef El-Fakey.
• Department of Anaesthesia, Faculty of Medicine, Ain-Shams University, Cairo, Egypt.
• J Opioid Manag. 2009 Jul 1;5(4):189-95.

PurposeEpidural morphine has been associated with a significant incidence of postoperative nausea and vomiting (PONV). The authors have evaluated the prophylactic effects of midazolam in preventing nausea and vomiting following epidural morphine for postoperative pain control.MethodsThe authors studied 80 women (n = 40 in each group) undergoing total abdominal hysterectomy under epidural anesthesia, in a randomized, double-blind, placebo-controlled study. At the end of the surgery, all patients received epidural morphine 3 mg for postoperative pain. Before morphine injection, the midazolam group received low-dose midazolam infusion (1 mg bolus followed by 1 mg h(-1)), while the placebo group received i.v. saline.ResultsPatients in the midazolam group reported a lower incidence of total PONV, and a lower frequency of rescue antiemetic request than those in the placebo group (p < 0.05). In addition, midazolam was associated with a reduced incidence of pruritus following epidural morphine (p < 0.05).ConclusionThe authors conclude that low-dose midazolam infusion is effective in the prevention of nausea, vomiting, and pruritus following epidural morphine for postoperative pain control.

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